Challenging the Current Concepts of Stem Cell Mobilization

Introduction
The first hematopoietic stem cell transplant (HSCT) for malignant disease was reported in 1957. Today more than 50,000 autologous (auto-SCT) and allogeneic (allo-SCT) stem cell transplants are performed annually for both malignant and non-malignant hematological disease. Since that first report, marked improvements to the procedure have resulted in increased numbers of long-term survivors and decreased adverse effects. Modifications of the graft, both in what it is composed of and how it is obtained, are among the many changes that have taken place over the years. Current sources for HSCT grafts include bone marrow, mobilized peripheral blood stem cells (PBSC), and cord blood. Today, more than 90% of auto-SCT and 70% of allo-SCT in adults are conducted using mobilized PBSC. The quality of the mobilized stem cell product, currently measured only by the quantity of CD34+ cells, is a critical factor for engraftment, and further optimization of the PBSC mobilization procedure may improve outcomes. Therefore, a prestigious group of 16 stem cell transplant experts from top institutions around the nation joined chair, Sergio A. Giralt, MD of The University of Texas, MD Anderson Cancer Center, to discuss the history, current status, and future directions of hematopoietic stem cell mobilization.

Media: Monograph
Estimated time to complete activity: 1.5 hours. Release date: July 24, 2009 | Expiration date: July 23, 2010

Statement of Need
A frequent approach to mobilizing stem cells for peripheral collection involves administering hematopoietic growth factors. Currently, granulocyte-colony-stimulating factor (G-CSF) and granulocyte-macrophage colony stimulating factor (GM-CSF) are used in the autologous setting, while G-CSF is predominately used in the allogeneic setting. Growth factors are generally administered for 4-6 days prior to cell collection to allow adequate time for CD34+ cell mobilization from bone marrow to peripheral circulation. Chemotherapy administration prior to growth factor is a common approach that may increase peripheral blood stem cells (PBSC) 5-15 fold, but also introduces the risk of chemotherapy toxicity. In current clinical practice, patients who do not mobilize enough CD34+ cells for collection following multiple attempts at apheresis may require painful bone marrow harvest. Novel methods for obtaining the optimal dose of stem cells in the most efficient manner for transplant represent a significant medical need in autologous SCT. Furthermore, continuing clinical investigation in the allogeneic setting may demonstrate improved convenience for normal donors, and pharmacoeconomic analysis may indicate health-system cost savings. Healthcare professionals caring for patients requiring stem cell mobilization prior to SCT need to understand the basis for emerging therapeutic options, and the preclinical and clinical data supporting the development and integration of novel mobilization regimens into clinical practice. This live educational program will address optimal integration of emerging therapeutic strategies regarding stem cell mobilization, describe the means of optimizing stem cell mobilization while minimizing adverse events, and provide a perspective for directions in stem cell mobilization.

Target Audience
The target audience for the program includes stem cell transplant physicians, hematologists, hematologist-oncologists, medical oncologists, oncology specialty pharmacists, and allied healthcare professionals charged with the care of patients undergoing stem cell transplant.

Learning Objectives
Upon completion of this educational program, participants should be better able to:

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